Office of the Medical Examiner

Transcription

1 Office of the Medical Examiner 2017 Annual Report **Report amended December 6, 2018 (page 21)**

2 Executive Summary Eaton County Ingham County Ionia County Isabella County Shiawassee County We are pleased to present our 2017 Annual Report. This report reflects the work of the Office of the Medical Examiner during the 2017 calendar year. Only those deaths that fall within the geographical jurisdiction of the Medical Examiner, which is based on the county in which death was pronounced, are included. We pride ourselves on providing outstanding service to the communities we serve. Our commitment to excellence was recognized in 2009, when our office was granted full accreditation by the National Association of Medical Examiners (NAME), and that full accreditation status was renewed by NAME in We have developed a regional system that delivers consistency and standardization. Thanks to leadership provided by Sparrow Forensic Pathology, there is an expected process which ensures quality, compassionate care when people need it most. It would not be possible for the Office of the Medical Examiner to operate efficiently without our dedicated staff. Additionally, our investigators are essential to our success and we are grateful for their service. The investigators are listed by county in the text of this report. 2

3 Sparrow Forensic Pathology Office of the Medical Examiner 2017 Staff Michael A. Markey, M.D. Medical Director John A. Bechinski, D.O. Patrick A. Hansma, D.O. Daniel L. Schultz, M.D. Luke R. Vogelsberg, D-ABMDI - Chief Investigator Holly Marsh - Administrative Assistant Debra Parsons - Team Advisor & Autopsy Assistant Brittany Buchholz Autopsy Assistant & In-House Investigations Samantha Schaeffer - Autopsy Assistant Krystin Smith - Autopsy Assistant Sarah Tresedder Autopsy Assistant 3

4 Medical Examiner Services Investigation of Deaths As the Office of the Medical Examiner for five counties in Michigan, we perform autopsies and other postmortem examinations as an important part of the death investigation process. Each county in Michigan has a licensed Physician, appointed by the County Commissioners, who is responsible for investigating deaths as defined by the Michigan Compiled Laws. In general, the deaths investigated by our office include those that are thought to result from injury or poisoning (such as homicide, suicide, and accidental deaths), and those deaths that are sudden, unexpected, and not readily explainable at the time of death. Because deaths occur around the clock, the Office of the Medical Examiner is staffed 24 hours a day, 365 days a year. The typical sequence of events that occurs following a death is: A death is reported to the on-call Medical Examiner Investigator (MEI). The MEI assesses whether we have legal authority and duty to investigate the death. The death scene is visited and investigated, if indicated. Investigative information is obtained about the decedent's medical and social history, as well as other information surrounding the events that were associated with the death. If an examination is indicated, the body is transported to the Forensic Pathology Laboratory at Sparrow Hospital in Lansing, MI. 4

5 If the investigator believes the death does not require a postmortem examination, the on-call Medical Examiner or Chief Investigator may be contacted to discuss the case before the body is released to the funeral home. An investigative report is written by the MEI. When applicable, the decedent s primary care physician is contacted and notified of the death, and medical history is confirmed. A death certificate is generated by either the decedent's personal physician, the attending physician in the medical facility, or the assigned Medical Examiner or Deputy Medical Examiner. If a postmortem examination is performed, following receipt and review of all appropriate test results and records, a postmortem examination report is written. Permanent records are maintained for future use, as needed, and distributed to those who have requested a copy of the report and are authorized to receive the report. Occasionally, some deaths require follow-up investigations, which are conducted by our In-House Investigators based at Sparrow Hospital. For 2017, this function was performed by Brittany Buchholz. Death Certification The main focus of our investigation is to determine the cause and manner of death, and to clarify circumstances surrounding the death. The cause of death is related to the underlying disease or injury that resulted in the individual's death. The manner of death, in the state of Michigan, is limited to these five options: natural, accident, suicide, homicide, or indeterminate. In addition, information gathered 5

6 during the investigation of event(s) before death and/or evidence collected may be critical for future legal proceedings. Case Management Approach A board-certified Forensic Pathologist is assigned to each death and determines the level of medical investigation required. Cases are handled by one of the following approaches: Direct Release - The body is released directly from the scene to the funeral director. The MEI is at the scene and views the body. Based upon scene and medical history information provided by the MEI to the on-call Medical Examiner or Chief Investigator, a decision may be made to release a body directly to the funeral home chosen by the family, without further examination. External Examination An external examination includes a detailed record of external observations of the body, and possible laboratory/toxicology testing. A report of external exam and laboratory findings is written by the responsible pathologist. Autopsy An autopsy includes an external examination as described above, as well as an internal examination. This internal examination may be a limited or partial autopsy, or a full or complete autopsy. A limited autopsy is an internal examination within a specific anatomic boundary (e.g. brain-only examination). Most often, limited autopsies are performed to recover a foreign body, surgical hardware, or answer specific questions. A full autopsy includes internal examination of all organs and body cavities. An autopsy usually includes laboratory/toxicology testing, and may include histologic examination and additional examination by a subspecialty consultant (e.g. cardiac or neuropathologist). A report of examination and laboratory findings is written by the responsible pathologist. 6

7 Decision to Autopsy The Medical Examiners and Deputy Medical Examiners use standards established by the National Association of Medical Examiners (NAME) to determine whether an autopsy is indicated. The standards, most recently revised in September 2016, state: The Forensic Pathologist shall perform a forensic autopsy when: The death is known or suspected to have been caused by apparent criminal violence. The death is unexpected and unexplained in an infant or child. The death is associated with police action. The death is apparently non-natural and in custody of a local, state, or federal institution. The death is due to acute workplace injury.* The death is caused by apparent electrocution.* The death is by apparent intoxication by alcohol, drugs, or poison, unless a significant interval has passed, and the medical findings and absence of trauma are well documented. The death is caused by unwitnessed or suspected drowning.* The body is unidentified and the autopsy may aid in identification. The body is skeletonized. The body is charred. The forensic pathologist deems a forensic autopsy is necessary to determine cause or manner of death, or document injuries/disease, or collect evidence. The deceased is involved in a motor vehicle incident and an autopsy is necessary to document injuries and/or determine the cause of death. * unless sufficient antemortem medical evaluation has adequately documented findings and issues of concern that would otherwise have required autopsy performance 7

8 Accreditation All of the Medical Examiners offices that contract for services with Sparrow Forensic Pathology are accredited by the National Association of Medical Examiners (NAME). Manner of Death Guidelines for classifying the manner of death include: Natural deaths are due solely or nearly totally to disease and/or the aging process. Accident applies when an injury or poisoning (including drug overdoses) causes death and there is little or no evidence that the injury or poisoning occurred with intent to harm or cause death. In essence, the fatal outcome was unintentional. Suicide results from an injury or poisoning as a result of an intentional selfinflicted act committed to do self-harm or cause the death of one's self. Homicide occurs when the death results from a volitional act committed by another person to cause fear, harm, or death. Intent to cause death is a common element but is not required for classification as a homicide. It has to be emphasized that the classification of homicide for the purpose of death certification is a "neutral" term and neither indicates nor implies criminal intent, which remains a determination within the province of legal processes. Indeterminate is a classification used when the information pointing to one manner of death is no more compelling than one or more other competing manners of death, in thorough consideration of all available information. 8

9 In general, when death involves a combination of natural processes and external factors, such as injury or poisoning, preference is given to the non-natural manner of death. Cremation Permit Authorizations Michigan law requires funeral directors to obtain a signed cremation permit from the Medical Examiner. Our office reviews thousands of cremation permit requests each year. We review the death certificates to ensure that deaths that should have been reported to our office were in fact reported. Deaths that were not properly reported are investigated before cremation is authorized. Testimony at Trials The Medical Examiner and Deputy Medical Examiners are often called upon to provide testimony in criminal and civil matters. They meet regularly with members of law enforcement, prosecutors, defense attorneys and civil litigators. Public Health and Safety Issues Although the major purpose of the Medical Examiner s Office is to conduct death investigations, the information obtained from individual death investigations may also be studied collectively to gather information that may be used to address public health and safety issues. Our office participates with the Michigan Child Death Review process in all counties, providing significant information regarding how children died, with the goal of preventing future deaths. Education We have a strong affiliation with Michigan State University. Our staff teaches pathology and provides regular lectures to forensic science students. We routinely 9

10 have medical students who rotate through our office to gain experience and exposure to forensic pathology. Additionally, we participate in many programs designed to teach youth about careers in forensic pathology. Comment on Methods and Terms This annual report reflects the activities of our medical examiner offices during a given calendar year. With rare exception (e.g., deaths reported to the wrong medical examiner office), the data include only those cases over which the county s medical examiner can exercise jurisdiction. Jurisdiction is determined by where the individual was pronounced dead rather than the county of residence or the county in which the incident leading to death might have occurred. Furthermore, the data reflect the calendar year in which the deaths were reported to the respective medical examiner offices, regardless of the year in which the death actually occurred. The category Total Deaths in the County is based upon numbers provided by that County Clerk s Office. Occasionally, these numbers may change after the time of publication of this report. The category Referrals to Gift of Life does not include in-hospital deaths reported to the medical examiner, which are referred to Gift of Life by hospital staff rather than the medical examiner office. For Accidental Deaths, the subcategory Vehicle consists of deaths that were classified as transportation-related fatalities, and include all forms of transport; drivers/operators, passengers, and pedestrians; this category does not include types of death that might otherwise fall into a different subclassification, such as vehicle fires and traumatic asphyxia. 10

11 Eaton County Medical Examiner Michael A. Markey, M.D. Deputy Medical Examiners John A. Bechinski, D.O. Patrick A. Hansma, D.O. Chief Investigator Luke R. Vogelsberg, D-ABMDI Medical Examiner Investigators Ruth Grant, D-ABMDI Jessica Nicholson Daniel Sowles, D-ABMDI Jane Wankmiller, Ph.D, D-ABMDI Mary Stevens David Lowndes Kevin Hearld 11

12 Eaton County Summary of Cases TOTAL DEATHS IN THE COUNTY DEATHS REPORTED TO THE ME CASES ACCEPTED FOR INVESTIGATION MEI SCENE INVESTIGATIONS DEATH CERTIFICATES SIGNED BY ME BODIES TRANSPORTED TO SPARROW COMPLETE AUTOPSY LIMITED AUTOPSY EXTERNAL EXAMINATION STORAGE ONLY UNCLAIMED BODIES REFERRALS TO GIFT OF LIFE TISSUE/CORNEA DONORS CREMATION PERMITS REVIEWED Not every case that is reported to the Medical Examiner s office falls within our jurisdiction. We accept cases for investigation based on the circumstances surrounding the death and the law that governs the Medical Examiner s authority (MCL ). We declined jurisdiction in 15 cases that were reported to us in Includes one non-human tissue case 12

13 Eaton County Manner of Death The data on the following pages refers to those deaths that were reported to the Medical Examiner s Office. Manner of Death NATURAL ACCIDENT SUICIDE HOMICIDE INDETERMINATE TOTAL Manner of Death Natural Accident Suicide Homicide Indeterminate 3 (2) multiple drug intoxication, (1) multiple injuries pedestrian struck by motor vehicle, (1) undetermined cause; severely decomposed body 4 (1) multiple drug intoxication, (1) sudden unexplained infant death 5 Cases with no manner of death: (1) non-human tissue 6 Cases with no manner of death: (1) non-human bones 13

14 Eaton County Accidental Deaths VEHICLE DRUG-RELATED DROWNING FALL FIRE ASPHYXIA HYPOTHERMIA OTHER TOTAL Accidental Deaths Vehicle Drug Related Fall All other (1) farm machinery accident 8 (1) rib fractures due to injury from back brace, (1) ruptured quadriceps tendon following syncopal episode 9 (1) natural disease complicated by environmental exposure, (1) delayed complications of anaphylaxis 14

15 Eaton County Drug-Related Deaths For purposes of this report, drug-related fatalities are deaths in which an overdose of a combination of drugs or a single drug caused or contributed to the death. These deaths do not include situations in which intoxication might have been a factor in an incident leading to death, such as motor vehicle crashes, falls, choking while eating, or environmental exposures. Manner of Death ACCIDENT SUICIDE INDETERMINATE TOTAL Drug-Related Deaths Accident Suicide Indeterminate 15

16 2017 Drug-Related Deaths TOTAL 15 cases SEX 3 female, 12 male RACE 15 white AGE RANGE years AVERAGE AGE 34.9 years MEDIAN AGE 31 years OPIOID-RELATED 12 cases involved an opiate or opioid (80%) MANNER OF DEATH 13 Accidents, 1 Suicide, 1 Indeterminate Accidental Drug-Related Deaths

17 Eaton County Suicides Suicide Totals by Year Suicide Methods FIREARM HANGING DRUG INTOXICATION SHARP FORCE INJURY SUFFOCATION OTHER Suicides by Age Electrocution 11 Drove in front of train 17

18 Eaton County Reported Deaths of Children Reported Deaths of Children by Age Stillborn <1 year TOTAL Reported Deaths of Children by Manner of Death Manner of Death NATURAL ACCIDENT SUICIDE HOMICIDE INDETERMINATE AGE SEX CAUSE OF DEATH MANNER months M Undetermined Indeterminate 15 years M Acute heroin toxicity Accident 17 years M Shotgun wound of head Suicide 18

19 Ingham County Medical Examiner Michael A. Markey, M.D. Deputy Medical Examiners John A. Bechinski, D.O. Patrick A. Hansma, D.O. Chief Investigator Luke R. Vogelsberg, D-ABMDI Medical Examiner Investigators Ashley Ault Dan Sowles, D-ABMDI Jane Wankmiller, Ph.D, D-ABMDI Joy Dempsey, D-ABMDI Kathleen Brooks Kevin Hearld Mark Chojnowski Megan Bohnett Steve Dexter, RN Brett Ramsden Erica Betts, D.O., MPH Jessica Nicholson Karen Phelps Ken Barnes Lynne Mark Mary Stevens Ruth Grant, D-ABMDI 19

20 Ingham County Summary of Cases TOTAL DEATHS IN THE COUNTY DEATHS REPORTED TO THE ME CASES ACCEPTED FOR INVESTIGATION MEI SCENE INVESTIGATIONS DEATH CERTIFICATES SIGNED BY ME BODIES TRANSPORTED TO SPARROW COMPLETE AUTOPSY LIMITED AUTOPSY EXTERNAL EXAMINATION STORAGE ONLY UNCLAIMED BODIES REFERRALS TO GIFT OF LIFE TISSUE/CORNEA DONORS CREMATION PERMITS REVIEWED Not every case that is reported to the Medical Examiner s office falls within our jurisdiction. We accept cases for investigation based on the circumstances surrounding the death and the law that governs the Medical Examiner s authority (MCL ). We declined jurisdiction in 239 cases that were reported to us in In previous years, this number was listed as the sum of exams (complete, limited, external) and bodies for storage only. In 2016, this number was obtained from the contracted transport provider, and thus excludes decedents who died at Sparrow hospital and would have been transported to the Sparrow morgue by Sparrow staff irrespective of their status as a ME or non- ME case. 20

21 Ingham County Manner of Death The data on the following pages refers to those deaths that were reported to the Medical Examiner s Office. Manner of Death NATURAL ACCIDENT SUICIDE HOMICIDE INDETERMINATE TOTAL Manner of Death Natural Accident Suicide Homicide Indeterminate 14 Based on new investigative information, one manner of death was changed from indeterminate to homicide on December 6, Based on new investigative information, one manner of death was changed from indeterminate to homicide on December 6, Cases with no manner of death: (3) stillbirths 17 Cases with no manner of death: (3) non-human bones 18 Cases with no manner of death: (2) stillbirths; (1) non-human bones 19 Cases with no manner of death: (1) products of conception; (1) stillbirth 20 Cases with no manner of death: (3) stillbirths; (1) human bone of no contemporary forensic interest 21 Cases with no manner of death: (1) stillbirth 21

22 Ingham County Accidental Deaths VEHICLE DRUG-RELATED DROWNING FALL FIRE ASPHYXIA HYPOTHERMIA OTHER TOTAL Accidental Deaths Vehicle Drug-Related Fall All other 22 Both decedents also acutely intoxicated with ethanol (these cases not included in drug-related category) 23 (1) anaphylaxis or other reaction to IV injection; (1) hemoperitoneum due to surgical injury; (2) blunt force injuries of head; (1) carbon monoxide intoxication 24 (1) exacerbation of chronic obstructive pulmonary disease by chemical respiratory irritant; (1) complications of dog bite; (1) injuries from falling tree; (1) carbon monoxide intoxication 25 (1) injuries from falling tree 26 (2) gunshot wound deaths; (1) struck by person falling from a ladder; (1) bowel obstruction by foreign object; (1) perforated bowel; (1) remote diving accident; (1) injuries from falling tree 27 (1) heart disease associated with anabolic androgenic steroid use; (1) methadone therapy contributing to complications of chronic ethanol abuse; (1) carbon monoxide intoxication 28 (1) complications of injury from boxing; (1) fall off bicycle; (1) multiple injuries struck by falling chimney; (1) pneumonia associated with acute and chronic ethanol use; (1) ingestion of poisonous mushroom; (1) rectal perforation from enema; (1) fell into wedged position on railroad blunt and compressive injuries; (1) esophageal rupture from acute and chronic ethanol use 22

23 Ingham County Drug-Related Deaths For purposes of this report, drug-related fatalities are deaths in which an overdose of a combination of drugs or a single drug caused or contributed to the death. These deaths do not include situations in which intoxication might have been a factor in an incident leading to death, such as motor vehicle crashes, falls, choking while eating, or environmental exposures. Manner of Death ACCIDENT SUICIDE INDETERMINATE TOTAL Drug-Related Deaths Accident Suicide Indeterminate 23

24 2017 Drug-Related Deaths TOTAL 101 cases SEX 42 female, 59 male RACE 90 white, 9 black, 1 Asian, 1 mixed race AGE RANGE years AVERAGE AGE 45 years MEDIAN AGE 46 years OPIOID-RELATED 79 cases involved an opiate or opioid (78.2%) MANNER OF DEATH 89 accidents, 8 suicides, 4 indeterminate Accidental Drug-Related Deaths

25 Ingham County Suicides Suicide Totals by Year Suicide Methods FIREARM HANGING DRUG INTOXICATION SUFFOCATION SHARP FORCE INJURY JUMP FROM HEIGHT DROWNING MOTOR VEHICLE CRASH CARBON MONOXIDE STRUCK BY TRAIN OTHER Suicides by Age Penetrating head trauma shot self with nail gun 25

26 Ingham County Reported Deaths of Children Sudden Unexplained Infant Death (SUID) refers to the death of an infant less than 1 year of age in which investigation, autopsy, medical history, review, and appropriate laboratory testing fails to identify a specific cause of death. SUID includes deaths that meet the definition of sudden infant death syndrome (SIDS). Reported Deaths of Children by Age Stillborn <1 year TOTAL Reported Deaths of Children by Manner of Death Manner of Death NATURAL ACCIDENT SUICIDE HOMICIDE INDETERMINATE

27 AGE SEX CAUSE OF DEATH MANNER F Intrauterine fetal demise N/A (stillbirth) 1 day F Unspecified natural causes not certified by ME Natural 3 days F Unconjugated hyperbilirubinemia with kernicterus Natural 1 month F Suffocation unsafe sleep Accident 2 months M Multiple injuries inflicted by other person(s) Homicide 3 months M Sudden unexplained infant death associated with unsafe sleep environment and upper respiratory tract infection Indeterminate 4 months M Unspecified natural causes not certified by ME Natural 7 months M Idiopathic pulmonary hemosiderosis Natural 8 months F Unspecified natural causes not certified by ME Natural 1 year M Drowning Accident 1 year F Undetermined Indeterminate 5 years M Multiple blunt force injuries pedestrian struck by vehicle Accident 10 years F Unspecified natural causes not certified by ME Natural 14 years F Multiple blunt force injuries motor vehicle crash Accident 14 years M Undetermined Natural 16 years M Hanging Suicide 17 years M Hanging Suicide 27

28 Ionia County Medical Examiner Michael A. Markey, M.D. Deputy Medical Examiners John A. Bechinski, D.O. Patrick A. Hansma, D.O. Chief Investigator Luke R. Vogelsberg, D-ABMDI Medical Examiner Investigators Ann Ward Derek Schroeder James Buxton James Jones John Sigg Katharine Dernocoeur Mark Crawfis Matthew Kasper, D-ABMDI Rick Vriesenga Rob Fisk Thomas Wodarek Timothy Thelen 28

29 Ionia County Summary of Cases Our contract with Ionia began in mid-january, The 2014 data reflect deaths that occurred between Jan. 22, 2014, and Dec. 31, TOTAL DEATHS IN THE COUNTY DEATHS REPORTED TO THE ME CASES ACCEPTED FOR INVESTIGATION MEI SCENE INVESTIGATIONS DEATH CERTIFICATES SIGNED BY ME BODIES TRANSPORTED TO SPARROW COMPLETE AUTOPSY LIMITED AUTOPSY EXTERNAL EXAMINATION STORAGE ONLY UNCLAIMED BODIES REFERRALS TO GIFT OF LIFE TISSUE/CORNEA DONORS CREMATION PERMITS REVIEWED Not every case that is reported to the Medical Examiner s office falls within our jurisdiction. We accept cases for investigation based on the circumstances surrounding the death and the law that governs the Medical Examiner s authority (MCL ). We declined jurisdiction in 3 cases that were reported to us in

30 Ionia County Manner of Death The data on the following pages refers to those deaths that were reported to the Medical Examiner s Office. Manner of Death NATURAL ACCIDENT SUICIDE HOMICIDE INDETERMINATE TOTAL Manner of Death Natural Accident Suicide Homicide Indeterminate

31 Ionia County Accidental Deaths VEHICLE DRUG-RELATED DROWNING FALL FIRE ASPHYXIA WATER INTOXICATION HYPOTHERMIA INDUSTRIAL ACCIDENT TOTAL Cause of Accidental Deaths Vehicle Drug-Related Fall All Other

32 Ionia County Drug Related Deaths For purposes of this report, drug related fatalities are deaths in which an overdose of a combination of drugs or a single drug caused or contributed to the death. These deaths do not include situations in which intoxication might have been a factor in an incident leading to death, such as motor vehicle crashes, falls, choking while eating, or environmental exposures ACCIDENT SUICIDE INDETERMINATE Drug-Related Deaths Accident Suicide Indeterminate

33 2017 Drug Related Deaths TOTAL 10 cases SEX 5 female, 5 male RACE 10 white AGE RANGE years AVERAGE AGE 38.9 years MEDIAN AGE 35 years OPIOID-RELATED 9 cases involved an opiate or opioid (90%) MANNER OF DEATH 7 accidents, 2 suicides, 1 indeterminate 12 Accidental Drug-Related Deaths

34 Ionia County Suicides Suicide Totals by Year Suicide Methods FIREARM HANGING DRUG INTOXICATION CARBON MONOXIDE MOTOR VEHICLE OTHER Suicides by Age Age (1) pedestrian struck by train 34

35 Ionia County Reported Deaths of Children Sudden Unexplained Infant Death (SUID) refers to the death of an infant less than 1 year of age in which investigation, autopsy, medical history, review, and appropriate laboratory testing fails to identify a specific cause of death. SUID includes deaths that meet the definition of sudden infant death syndrome (SIDS). Reported Deaths of Children by Age Stillborn <1 year TOTAL Reported Deaths of Children by Manner of Death Manner of Death NATURAL ACCIDENT SUICIDE HOMICIDE INDETERMINATE

36 AGE SEX CAUSE OF DEATH MANNER months M Undetermined possible unsafe sleep Indeterminate 13 years M Complications of Goldenhar Syndrome Natural 16 years M Stab wound of neck Homicide 36

37 Isabella County Medical Examiner Michael A. Markey, M.D. Deputy Medical Examiners John A. Bechinski, D.O. Patrick A. Hansma, D.O. Chief Investigator Luke R. Vogelsberg, D-ABMDI Medical Examiner Investigators Christy Mead Kari Duman Mary Stevens Matthew Drake Michael Rohn Philip Nartker Richard Clark Robert Schumacker Taylor Hoekwater 37

38 Isabella County Summary of Cases TOTAL DEATHS IN THE COUNTY DEATHS REPORTED TO THE ME CASES ACCEPTED FOR INVESTIGATION MEI SCENE INVESTIGATIONS DEATH CERTIFICATES SIGNED BY ME BODIES TRANSPORTED TO SPARROW COMPLETE AUTOPSY LIMITED AUTOPSY EXTERNAL EXAMINATION STORAGE ONLY UNCLAIMED BODIES REFERRALS TO GIFT OF LIFE TISSUE/CORNEA DONORS CREMATION PERMITS REVIEWED Not every case that is reported to the Medical Examiner s office falls within our jurisdiction. We accept cases for investigation based on the circumstances surrounding the death and the law that governs the Medical Examiner s authority (MCL ). We declined jurisdiction in 8 cases that were reported to us in

39 Isabella County Manner of Death Manner of Death NATURAL ACCIDENT SUICIDE HOMICIDE INDETERMINATE TOTAL Manner of Death Natural Accident Suicide Homicide Indeterminate Case with no manner of death: stillborn following motor vehicle crash 34 Case with no manner of death: stillbirth 35 Case with no manner of death: stillbirth 39

40 Isabella County Accidental Deaths VEHICLE DRUG-RELATED DROWNING FALL ASPHYXIA HYPOTHERMIA ANIMAL FALLING TREE PINNED IN MACHINERY TOTAL Cause of Accidental Deaths Vehicle Drug-Related Fall All other

41 Isabella County Drug Related Deaths For purposes of this report, drug related fatalities are deaths in which an overdose of a combination of drugs or a single drug caused or contributed to the death. These deaths do not include situations in which intoxication might have been a factor in an incident leading to death, such as motor vehicle crashes, falls, choking while eating, or environmental exposures. Manner of Death ACCIDENT SUICIDE INDETERMINATE Drug-Related Deaths Accident Suicide Indeterminate

42 2017 Drug Related Deaths TOTAL 9 cases SEX 4 female, 5 male RACE 5 white, 4 Native American AGE RANGE years AVERAGE AGE 38.3 years MEDIAN AGE 39 years OPIOD-RELATED 8 cases involved an opiate or opioid (88.9%) MANNER OF DEATH 8 accidents, 1 suicide Accidental Drug-Related Deaths

43 Isabella County Suicides Suicide Totals by Year Suicide Methods FIREARM HANGING ASPHYXIA DRUG INTOXICATION Suicides by Age Age

44 Isabella County Reported Deaths of Children Sudden Unexplained Infant Death (SUID) refers to the death of an infant less than 1 year of age in which investigation, autopsy, medical history, review, and appropriate laboratory testing fails to identify a specific cause of death. SUID includes deaths that meet the definition of sudden infant death syndrome (SIDS). Reported Deaths of Children by Age Stillborn <1 year TOTAL Reported Deaths of Children by Manner of Death Manner of Death NATURAL ACCIDENT SUICIDE HOMICIDE INDETERMINATE

45 AGE SEX CAUSE OF DEATH MANNER F Stillborn N/A (stillbirth) 4 years F Blunt force head trauma (motor vehicle crash) Accident 17 years M Drowning Accident 45

46 Shiawassee County Medical Examiner Michael A. Markey, M.D. Deputy Medical Examiners John A. Bechinski, D.O. Patrick A. Hansma, D.O. Chief Investigator Luke R. Vogelsberg, D-ABMDI Medical Examiner Investigators Mark Pendergraff, D-ABMDI Dennis Campbell Ashley Ault Lawrence Goff Nicholas Stratton Shane Grinnell MaryLynn Jordan Mary Valentine 46

47 Shiawassee County Summary of Cases TOTAL DEATHS IN THE COUNTY DEATHS REPORTED TO THE ME CASES ACCEPTED FOR INVESTIGATION MEI SCENE INVESTIGATIONS DEATH CERTIFICATES SIGNED BY ME BODIES TRANSPORTED TO SPARROW COMPLETE AUTOPSY LIMITED AUTOPSY EXTERNAL EXAMINATION STORAGE ONLY REFERRALS TO GIFT OF LIFE TISSUE/CORNEA DONORS UNCLAIMED BODIES CREMATION PERMITS REVIEWED Not every case that is reported to the Medical Examiner s office falls within our jurisdiction. We accept cases for investigation based on the circumstances surrounding the death and the law that governs the Medical Examiner s authority (MCL ). We declined jurisdiction in 17 cases that were reported to us in

48 Shiawassee County Manner of Death Manner of Death NATURAL ACCIDENT SUICIDE HOMICIDE INDETERMINATE TOTAL Manner of Death Natural Accident Suicide Homicide Indeterminate Cases with no manner of death: (2) stillbirths; (1) non-human material 38 Cases with no manner of death: stillbirth 39 Cases with no manner of death: (1) stillbirth; (1) found trophy human skull of no contemporary forensic interest 48

49 Shiawassee County Accidental Deaths VEHICLE DRUG-RELATED DROWNING FALL FIRE ASPHYXIA INSECT STING(S) HYPOTHERMIA OTHER TOTAL Accidental Deaths Total Vehicle Drug Related Fall 40 (1) carbon monoxide toxicity; (1) electrocution 41 (1) perforated artery during attempt at catheter placement; (1) compressed by machinery 42 Hypothermia complicated by multiple drug intoxication, blunt head trauma, and cardiopulmonary disease 49

50 Shiawassee County Drug Related Deaths For purposes of this report, drug related fatalities are deaths in which an overdose of a combination of drugs or a single drug caused or contributed to the death. These deaths do not include situations in which intoxication might have been a factor in an incident leading to death, such as motor vehicle crashes, falls, choking while eating, or environmental exposures. Manner of Death ACCIDENT SUICIDE INDETERMINATE TOTAL Drug Related Deaths Accident Suicide Indeterminate 43 (1) case is multifactorial hypothermia complicated by multiple drug intoxication, blunt head injuries, and cardiopulmonary disease (explains discrepancy in total number of accidental drug-related deaths between this chart and that on previous page) 50

51 2017 Drug Related Deaths TOTAL 17 cases SEX 5 female, 12 male RACE 17 white AGE RANGE years AVERAGE AGE 45.3 years MEDIAN AGE 33 years OPIOD-RELATED 17 cases involved an opiate or opioid (100%) MANNER OF DEATH 15 accidents, 2 suicides Accidental Drug-Related Deaths

52 Shiawassee County Suicides Suicide Totals by Year Suicide Methods FIREARM HANGING DRUG INTOXICATION CARBON MONOXIDE MOTOR VEHICLE CRASH STRUCK BY TRAIN Suicides by Age Age Motor vehicle parked on train trucks struck by train in motor vehicle 52

53 Shiawassee County Reported Deaths of Children Reported Deaths of Children by Age Stillborn <1 year TOTAL Reported Deaths of Children by Manner of Death Manner of Death NATURAL ACCIDENT SUICIDE HOMICIDE INDETERMINATE AGE SEX CAUSE OF DEATH MANNER F Stillbirth intrauterine fetal demise N/A (stillbirth) 25 days F Undetermined possible unsafe sleep Indeterminate 53

54 Comparisons Across Counties Eaton Ingham Ionia Isabella Shiawassee POPULATION , ,895 63,905 70,311 70,648 TOTAL DEATHS 783 2, DEATHS REPORTED TO THE ME (% OF TOTAL DEATHS) CASES ACCEPTED FOR INVESTIGATION MEI SCENE INVESTIGATION DEATH CERTIFICATES SIGNED BY ME TOTAL EXAMS (% OF CASES ACCEPTED) 191 (24.4%) 916 (31.9%) 113 (32.5%) 118 (22.3%) 168 (27.2%) (41.5%) 286 (42.2%) 51 (46.4%) 45 (40.9%) 51 (33.8%) NATURAL DEATHS (% OF DEATHS REPORTED) 128 (67.0%) 605 (66.0%) 71 (62.8%) 75 (63.6%) 125 (74.4%) ACCIDENTAL DEATHS (% OF DEATHS REPORTED) 38 (19.9%) 231 (25.2%) 24 (21.2%) 29 (24.6%) 26 (15.5%) 45 Population statistics provided by suburbanstats.org 54

55 Eaton Ingham Ionia Isabella Shiawassee SUICIDES (% OF DEATHS REPORTED) 20 (10.5%) 44 (4.8%) 14 (12.4%) 10 (8.5%) 11 (6.5%) HOMICIDES (% OF DEATHS REPORTED) INDETERMINATE (% OF DEATHS REPORTED) DRUG-RELATED DEATHS (% OF DEATHS REPORTED) REFERRALS TO GIFT OF LIFE TISSUE/CORNEA DONORS 3 (1.6%) 2 (1.1%) 15 (7.9%) 19 (2.1%) 16 (1.7%) 101 (11.0%) 1 (0.9%) 3 (2.7%) 10 (8.8%) 0 (0%) 3 (2.5%) 9 (7.6%) 3 (1.8%) 1 (0.6%) 11 (6.6%) UNCLAIMED BODIES

56 Additional Information In the five counties for which Sparrow Forensic Pathology served as the Office of the Medical Examiner in 2017: Zero bodies were exhumed for examination Zero bodies remained unidentified at the time a final disposition for the remains was determined Toxicology testing was performed in 495 of the 512 examinations performed Toxicology testing is performed in nearly all cases in which an examination is performed. Exceptions to this may include (but are not limited to): cases sent in for identification purposes only, apparent natural deaths sent in for external examination to rule out trauma, and cases for which adequate toxicology specimens cannot be obtained (due to prolonged stay in hospital following initial event, or decomposition). 56